Reviews of perinatal care have consistently pointed to failures of communication among the care team and documentation of care as common factors in adverse events that occur in labor and delivery. They are also prime factors leading to malpractice claims.

Idealized Design of Perinatal Care is an innovation project based on the principles of reliability science and the Institute for Healthcare Improvement’s (IHI’s) model for applying these principles to improve care. The Idealized Design model focuses on comprehensive redesign to enable a care system to perform substantially better in the future than the best it can do at present. The goal of Idealized Design of Perinatal Care is to achieve a new level of safer, more effective care and to minimize some of the risks identified in medical malpractice cases.

The model described in this white paper, Idealized Design of Perinatal Care, represents the Institute for Healthcare Improvement’s best current assessment of the components of the safest and most reliable system of perinatal care. The four key components of the model are:

The development of reliable clinical processes to manage labor and delivery

The use of principles that improve safety (i.e., preventing, detecting, and mitigating errors)

The establishment of prepared and activated care teams that communicate effectively with each other and with mothers and families

A focus on mother and family as the locus of control during labor and delivery

Two perinatal care "bundles" — a group of evidence-based interventions related to a disease or care process that, when executed together, result in better outcomes than when implemented individually — are being tested in this Idealized Design project: the Elective Induction Bundle and the Augmentation Bundle. The assumption of this innovation work is that reliably applying these evidence-based interventions in the delivery of perinatal care can dramatically improve outcomes.

This white paper provides detail about the Idealized Design process and examines some of the initial work completed by teams in the innovation project.